Endophthalmitis

Endophthalmitis is an infection inside the eyeball which can rapidly cause blindness.

With the increase in patients attending practice for extended services post-operative follow up examinations such as post-cataract check-ups, there is an increased risk that patient may present with symptoms of endophthalmitis. (The risk factor for endophthalmitis following cataract surgery is c.0.1% of cases)

This is a rare but very serious, sight threatening condition and is normally a post-operative infection which occurs within the first two weeks of surgery.

There are two types of endophthalmitis:

Exogenous endophthalmitis – the infection is introduced to the eye from an outside source.

Endogenous endophthalmitis – the infection spreads from another site within the body.

Signs/Symptoms:

  • Corneal haze
  • Swollen eyelids
  • Cells and flare in aqueous chamber
  • Pain – mild to severe
  • Photophobia
  • Drop in vision
  • Conjunctival hyperaemia
  • Conjunctival chemosis
  • Hypopyon visible – a collection of pus behind the cornea (see image below)
  • Recent surgery is a risk factor

Causes:

  • Post-surgical treatments for cataract, glaucoma, retinal or macula surgery or intravitreal injections for AMD. Typically the infections are by bacteria such as Staphylococcus species, Streptococcus species, gram-negative bacteria.
  • Diabetes mellitus, renal failure and acquired immunodeficiency syndrome are all risk factors for endogenous endophthalmitis
  • Foreign body in situ introducing infection

 

Endophthalmitis often causes an hypopyon which is the collection of yellowish fluid seen at the bottom of the iris in the photograph.

This finding prompts immediate emergency referral. Hypopyon can be seen in other conditions (see iritis ) and always indicates a serious problem which requires an emergency referral.

Treatment:

• Removal of foreign body if still in situ
• Intravitreal antibiotics
• Possible steroid treatment to reduce inflammation

Red Flags:

• Can occur from endogenous spread of infection in septic patients or ones with deep-tissue infections
• Can be life threatening
• Any patient reporting signs and symptoms as described above should be immediately referred

When one or more of these red flags is raised, a conversation with another registrant in practice should take place following which appropriate referral or management should be actioned and noted. If there are no other registrants in practice then contact should be made with colleagues elsewhere or contact should be made for advice to the local Hospital Eye Service.